title: [Open heart surgery in a Jehovah's Witness boy--a case report of successful management of aortic regurgatation and aneurysm of sinus Valsalva due to infective endocarditis].
abstract: Jehovah's Witness who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report an 8-year-old male of Jehovah's Witness who underwent a surgical treatment of infective endocarditis. He was transferred to our hospital because of high fever and heart murmur. Echocardiogram revealed a developing vegetation of aortic cusps and an aneurysmal change of the non-coronary sinus Valsalva. On admission he was complicated by anemia, purulent meningitis and suppurative arthritis of left knee. There were no signs of cardiac failure. Erythropoietin (6000 U thrice weekly) and iron (60 mg daily) were given for 11 weeks prior to surgery, raising the hemoglobin level from 9.2 g/dl to 18.4 g/dl. Aortic valve replacement and plasty of the sinus Valsalva were then performed. Intraoperatively hemoglobin concentration dropped to 10.3 g/dl and it raised to 15 g/dl postoperatively. We also used Cell-Saver to reduce blood loss. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sawada
authors.forename: K
authors.initials: K
authors.lastname: Asada
authors.forename: N
authors.initials: N
authors.lastname: Matsuyama
authors.forename: S
authors.initials: S
authors.lastname: Hasegawa
authors.forename: S
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002835:Christianity; D004697:Endocarditis, Bacterial / Q000150:complications*; D004921:Erythropoietin / Q000627:therapeutic use; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D012850:Sinus of Valsalva
chemical_list: D004921:Erythropoietin